Low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome at a single center
Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. Understanding local barriers to LTVV use at a former ARDS Network hospital may provide new insight to improve LTVV implementation. A cohort of 214 randomly selected adults met the Berlin def...
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| Veröffentlicht in: | Journal of critical care 2018-04, Vol.44, p.72-76 |
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| creator | Spece, Laura J. Mitchell, Kristina H. Caldwell, Ellen S. Gundel, Stephanie J. Jolley, Sarah E. Hough, Catherine L. |
| description | Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. Understanding local barriers to LTVV use at a former ARDS Network hospital may provide new insight to improve LTVV implementation.
A cohort of 214 randomly selected adults met the Berlin definition of ARDS at Harborview Medical Center between 2008 and 2012. The primary outcome was the receipt of LTVV (tidal volume of ≤6.5mL/kg predicted body weight) within 48h of ARDS onset. We constructed a multivariable logistic regression model to identify factors associated with the outcome.
Only 27% of patients received tidal volumes of ≤6.5mL/kg PBW within 48h of ARDS onset. Increasing plateau pressure (OR 1.11; 95% CI 1.03 to 1.19; p-value |
| doi_str_mv | 10.1016/j.jcrc.2017.10.021 |
| format | Article |
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A cohort of 214 randomly selected adults met the Berlin definition of ARDS at Harborview Medical Center between 2008 and 2012. The primary outcome was the receipt of LTVV (tidal volume of ≤6.5mL/kg predicted body weight) within 48h of ARDS onset. We constructed a multivariable logistic regression model to identify factors associated with the outcome.
Only 27% of patients received tidal volumes of ≤6.5mL/kg PBW within 48h of ARDS onset. Increasing plateau pressure (OR 1.11; 95% CI 1.03 to 1.19; p-value<0.01) was positively associated with LTVV use while increasing PaO2:FIO2 ratio was negatively associated (OR 0.75; 95% CI 0.57 to 0.98; p-value 0.03). Physicians documented an ARDS diagnosis in only 21% of the cohort. Neither patient height nor gender was associated with LTVV use.
Most ARDS patients did not receive LTVV despite implementation of a protocol. ARDS was also recognized in a minority of patients, suggesting an opportunity for improvement of care.</description><identifier>ISSN: 0883-9441</identifier><identifier>EISSN: 1557-8615</identifier><identifier>DOI: 10.1016/j.jcrc.2017.10.021</identifier><identifier>PMID: 29073535</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; ARDS ; Critical care ; Female ; Humans ; Intensive Care Units - statistics & numerical data ; Logistic Models ; Low-tidal volume ventilation ; Male ; Middle Aged ; Mortality ; Quality of care ; Respiration, Artificial - methods ; Respiratory distress syndrome ; Respiratory Distress Syndrome, Adult - mortality ; Respiratory Distress Syndrome, Adult - therapy ; Respiratory therapy ; Tidal Volume ; Ventilation ; Ventilators</subject><ispartof>Journal of critical care, 2018-04, Vol.44, p.72-76</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 1, 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-c976f34cf64d65ad8c5bbe5b09872e6601d9ae5f5372c5b5e76cf2951b66a3883</citedby><cites>FETCH-LOGICAL-c428t-c976f34cf64d65ad8c5bbe5b09872e6601d9ae5f5372c5b5e76cf2951b66a3883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2012331419?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,64361,64363,64365,65309,72215</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29073535$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spece, Laura J.</creatorcontrib><creatorcontrib>Mitchell, Kristina H.</creatorcontrib><creatorcontrib>Caldwell, Ellen S.</creatorcontrib><creatorcontrib>Gundel, Stephanie J.</creatorcontrib><creatorcontrib>Jolley, Sarah E.</creatorcontrib><creatorcontrib>Hough, Catherine L.</creatorcontrib><title>Low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome at a single center</title><title>Journal of critical care</title><addtitle>J Crit Care</addtitle><description>Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. Understanding local barriers to LTVV use at a former ARDS Network hospital may provide new insight to improve LTVV implementation.
A cohort of 214 randomly selected adults met the Berlin definition of ARDS at Harborview Medical Center between 2008 and 2012. The primary outcome was the receipt of LTVV (tidal volume of ≤6.5mL/kg predicted body weight) within 48h of ARDS onset. We constructed a multivariable logistic regression model to identify factors associated with the outcome.
Only 27% of patients received tidal volumes of ≤6.5mL/kg PBW within 48h of ARDS onset. Increasing plateau pressure (OR 1.11; 95% CI 1.03 to 1.19; p-value<0.01) was positively associated with LTVV use while increasing PaO2:FIO2 ratio was negatively associated (OR 0.75; 95% CI 0.57 to 0.98; p-value 0.03). Physicians documented an ARDS diagnosis in only 21% of the cohort. Neither patient height nor gender was associated with LTVV use.
Most ARDS patients did not receive LTVV despite implementation of a protocol. ARDS was also recognized in a minority of patients, suggesting an opportunity for improvement of care.</description><subject>Adult</subject><subject>Aged</subject><subject>ARDS</subject><subject>Critical care</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Logistic Models</subject><subject>Low-tidal volume ventilation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Quality of care</subject><subject>Respiration, Artificial - methods</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Distress Syndrome, Adult - mortality</subject><subject>Respiratory Distress Syndrome, Adult - therapy</subject><subject>Respiratory therapy</subject><subject>Tidal Volume</subject><subject>Ventilation</subject><subject>Ventilators</subject><issn>0883-9441</issn><issn>1557-8615</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kUtv1DAUhS1ERYeWP8ACWWLDJlM_YjuR2KCKlzQSG7q2HOcGHCXxYDtTzb_nRlNYsGBl-d7vHNnnEPKasz1nXN-N-9EnvxeMGxzsmeDPyI4rZapGc_Wc7FjTyKqta35NXuY8MgSlVC_ItWiZkUqqHSmH-EhL6N1ET3FaZ6AnWEqYXAlxoWsGmmB2Ycl0QjAs9IgbJDJ9DOUndX4tG5KPIbkS05n2IRe8Z5rPS58iGrpCHc1h-TEB9SiFdEuuBjdlePV03pCHTx-_33-pDt8-f73_cKh8LZpS-dboQdZ-0HWvlesbr7oOVMfaxgjQmvG-daAGJY3AlQKj_SBaxTutncS_35B3F99jir9WyMXOIXuYJrdAXLPlrTK1UVpqRN_-g45xTQu-zmK-Qkpe8xYpcaF8ijknGOwxhdmls-XMbp3Y0W6dbBqzzbATFL15sl67Gfq_kj8lIPD-AgBmcQqQbPaYsYc-JPDF9jH8z_83RBqeqA</recordid><startdate>201804</startdate><enddate>201804</enddate><creator>Spece, Laura J.</creator><creator>Mitchell, Kristina H.</creator><creator>Caldwell, Ellen S.</creator><creator>Gundel, Stephanie J.</creator><creator>Jolley, Sarah E.</creator><creator>Hough, Catherine L.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201804</creationdate><title>Low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome at a single center</title><author>Spece, Laura J. ; Mitchell, Kristina H. ; Caldwell, Ellen S. ; Gundel, Stephanie J. ; Jolley, Sarah E. ; Hough, Catherine L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-c976f34cf64d65ad8c5bbe5b09872e6601d9ae5f5372c5b5e76cf2951b66a3883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>ARDS</topic><topic>Critical care</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Logistic Models</topic><topic>Low-tidal volume ventilation</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Quality of care</topic><topic>Respiration, Artificial - methods</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory Distress Syndrome, Adult - mortality</topic><topic>Respiratory Distress Syndrome, Adult - therapy</topic><topic>Respiratory therapy</topic><topic>Tidal Volume</topic><topic>Ventilation</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spece, Laura J.</creatorcontrib><creatorcontrib>Mitchell, Kristina H.</creatorcontrib><creatorcontrib>Caldwell, Ellen S.</creatorcontrib><creatorcontrib>Gundel, Stephanie J.</creatorcontrib><creatorcontrib>Jolley, Sarah E.</creatorcontrib><creatorcontrib>Hough, Catherine L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of critical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spece, Laura J.</au><au>Mitchell, Kristina H.</au><au>Caldwell, Ellen S.</au><au>Gundel, Stephanie J.</au><au>Jolley, Sarah E.</au><au>Hough, Catherine L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome at a single center</atitle><jtitle>Journal of critical care</jtitle><addtitle>J Crit Care</addtitle><date>2018-04</date><risdate>2018</risdate><volume>44</volume><spage>72</spage><epage>76</epage><pages>72-76</pages><issn>0883-9441</issn><eissn>1557-8615</eissn><abstract>Low tidal volume ventilation (LTVV) reduces mortality in acute respiratory distress syndrome (ARDS) patients. Understanding local barriers to LTVV use at a former ARDS Network hospital may provide new insight to improve LTVV implementation.
A cohort of 214 randomly selected adults met the Berlin definition of ARDS at Harborview Medical Center between 2008 and 2012. The primary outcome was the receipt of LTVV (tidal volume of ≤6.5mL/kg predicted body weight) within 48h of ARDS onset. We constructed a multivariable logistic regression model to identify factors associated with the outcome.
Only 27% of patients received tidal volumes of ≤6.5mL/kg PBW within 48h of ARDS onset. Increasing plateau pressure (OR 1.11; 95% CI 1.03 to 1.19; p-value<0.01) was positively associated with LTVV use while increasing PaO2:FIO2 ratio was negatively associated (OR 0.75; 95% CI 0.57 to 0.98; p-value 0.03). Physicians documented an ARDS diagnosis in only 21% of the cohort. Neither patient height nor gender was associated with LTVV use.
Most ARDS patients did not receive LTVV despite implementation of a protocol. ARDS was also recognized in a minority of patients, suggesting an opportunity for improvement of care.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29073535</pmid><doi>10.1016/j.jcrc.2017.10.021</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged ARDS Critical care Female Humans Intensive Care Units - statistics & numerical data Logistic Models Low-tidal volume ventilation Male Middle Aged Mortality Quality of care Respiration, Artificial - methods Respiratory distress syndrome Respiratory Distress Syndrome, Adult - mortality Respiratory Distress Syndrome, Adult - therapy Respiratory therapy Tidal Volume Ventilation Ventilators |
| title | Low tidal volume ventilation use remains low in patients with acute respiratory distress syndrome at a single center |
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